Highly Active Antiretroviral Therapy Use and HIV Transmission Risk Behaviors Among Individuals Who Are HIV Infected and Were Recently Released From Jail

The authors evaluated highly active antiretroviral therapy (HAART) use and risk behaviors among 177 inmates who were HIV-infected and were released and then re-incarcerated in San Francisco jails during a 12-month period. A quarter of the adults who are HIV-infected in the United States pass through correctional facilities annually.

Interviews with study participants assessed sociodemographics, incarceration history and use of supportive services the month preceding re-incarceration. They were also screened for depression, and questioned about past or present alcohol dependence and sexual and drug use behaviors. Participants were given a pill card with pictures to determine antiretroviral use during the preceding month and asked about doses missed.

In general, participants were economically disadvantaged and repeat incarceration was common. A majority were homeless the month preceding incarceration. Risk-taking behavior included sero-discordant unprotected sexual intercourse (27 percent-38 percent) and syringe sharing (17 percent). Although almost two-thirds had a history of antiretroviral use, 59 percent (n=64) of this group did not use HAART the month preceding incarceration. Among HAART users, 52 percent missed medication doses once a week or more.

The discontinuation of HAART was independently associated with homelessness, marijuana use, injection drug use, and the lack of community medical care.

According to the authors: "Suboptimal HAART use while in the community compromises the personal health of ex-offenders and may increase HIV transmission, including transmission of drug-resistant strains. This is particularly troubling given the rates of serodiscordant unprotected sexual intercourse and distributive syringe sharing we observed and others have reported."

The authors concluded that the study results "highlight the need for coordinated public health interventions that begin during incarceration and continue post-release. Such interventions are critical to improving health outcomes for inmates who are HIV-infected and preventing further HIV transmission in the community."

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